Lloyd T R, Fedderly R, Mendelsohn A M, Sandhu S K, Beekman R H
Department of Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, Mich.
Circulation. 1993 Oct;88(4 Pt 1):1412-20. doi: 10.1161/01.cir.88.4.1412.
Transcatheter occlusion with Gianturco coils has been attempted in a small number of patients with tiny (< or = 1.5-mm diameter) patent ductus arteriosus, and preliminary results have been encouraging. The present study extends this method to larger ductus sizes and makes recommendations for proper coil size selection.
Coil occlusion was attempted in 24 consecutive patients with patent ductus arteriosus who did not require other cardiac surgery. Median patient age was 4.2 years (8 months to 30 years), and mean ductus diameter was 1.7 +/- 0.8 mm. Two instances of coil embolization occurred in the first 4 patients, with successful coil retrieval. Based on this experience, we proposed that the coil helical diameter should be twice or more the minimum ductus diameter, with coil length sufficient for three or more loops. With these recommendations, coils were successfully implanted in the subsequent 20 consecutive patients. Of the 22 patients with successful coil implantation, 15 (68%) had no residual shunting, and 7 had trace residual shunting by angiography. The continuous murmur was abolished in all 22 patients. No significant complications occurred, and all patients were discharged within 24 hours of successful coil implantation. No change in the systolic pressure gradient between main and left pulmonary artery or ascending and descending aorta was observed.
Transcatheter occlusion of patent ductus arteriosus can be safely and effectively achieved in patients with ductus diameters up to 3.3 mm. Coil occlusion does not cause obstruction to flow in the left pulmonary artery or descending aorta. Coils should be selected to provide a helical diameter twice or more the minimum ductus diameter and a length sufficient for three or more loops.
少数患有微小（直径≤1.5毫米）动脉导管未闭的患者已尝试使用弹簧圈经导管封堵，初步结果令人鼓舞。本研究将此方法扩展至更大直径的动脉导管，并对合适弹簧圈尺寸的选择提出建议。
对24例无需进行其他心脏手术的动脉导管未闭患者连续进行弹簧圈封堵尝试。患者年龄中位数为4.2岁（8个月至30岁），动脉导管平均直径为1.7±0.8毫米。前4例患者中有2例发生弹簧圈栓塞，弹簧圈成功取出。基于这一经验，我们建议弹簧圈的螺旋直径应至少为动脉导管最小直径的两倍，弹簧圈长度应足以形成三个或更多的圈。按照这些建议，随后连续20例患者的弹簧圈成功植入。在22例弹簧圈植入成功的患者中，15例（68%）无残余分流，7例经血管造影显示有微量残余分流。所有22例患者的连续性杂音均消失。未发生重大并发症，所有患者在弹簧圈植入成功后24小时内出院。主肺动脉与左肺动脉之间或升主动脉与降主动脉之间的收缩压差未见变化。
对于直径达3.3毫米的动脉导管未闭患者，经导管封堵可安全有效地实现。弹簧圈封堵不会导致左肺动脉或降主动脉血流受阻。应选择螺旋直径至少为动脉导管最小直径两倍且长度足以形成三个或更多圈的弹簧圈。
